PROTEIN-LOSING ENTEROPATHIES

摘要

When concerned with protein loss of any cause, one should measure serum albumin concentrations as opposed to the serum total protein concentration. Do not use human clinical pathology laboratories because their technology sometimes does not detect canine albumin; this means that they routinely report serum albumin concentrations of < 1.5 gm/dl in clinically normal dogs. If the patient has substantial hypoalbuminemia, the first step is to examine the skin for obvious lesions which can cause protein loss. Cutaneous lesions sufficient to cause such hypoalbuminemia are obvious; you should be able to just look at the patient and know if this is the problem or not. Next, hepatic function testing (e.g., resting and post-prandial serum bile acid concentrations) and a urinalysis are requested. If there is any doubt on the urinalysis, then a urine proteinxreatinine ratio will quantify the magnitude of urinary protein loss. Severe hypoalbuminemia (i.e., < 2 gm/dl) in an animal with diarrhea suggests a protein-losing enteropathy (PLE); however, diarrhea (even when severe) in no way is sufficient to eliminate hepatic disease as the cause of the hypoalbuminemia. Furthermore, a very substantial number of dogs and cats with PLE do not have vomiting or diarrhea. Some only have ascites, and some are found fortuitously on routine blood work. This may be especially true of dogs with primary intestinal lymphangiectasia.